Journal of Parenteral and Enteral Nutrition最新文献

{"title":"New International Classification of Diseases, 11th Revision code for the diagnosis of adult undernutrition in clinical settings","authors":"Gordon L. Jensen MD, PhD, Alison Steiber PhD, RDN, Charlene Compher PhD, RD","doi":"10.1002/jpen.70054","DOIUrl":"10.1002/jpen.70054","url":null,"abstract":"<p>A new <i>International Classification of Diseases, Eleventh Revision</i> (<i>ICD-11</i>) code, “Undernutrition in adults,” has been approved by the World Health Organization (WHO) for implementation in 2027. However, it is likely that adoption of ICD-11 in the USA may be delayed compared to that of other countries and the timeline is at present unclear. The USA develops its own clinical modification (CM—ICD 11 CM) to meet USA reporting and billing requirements. The prior implementation of ICD-10 and transition from ICD-9 was much delayed. We want our clinicians to be aware that other countries will be moving forward with the new ICD-11 undernutrition code. It is prudent to begin consideration of potential impacts and implementation requirements for future adoption in the USA.</p><p>Note that the WHO has specifically elected to use undernutrition terminology for this code. This coding advance encompasses a modern understanding of disease-related contributions to undernutrition in adult patients. Practitioners across the globe confront adult undernutrition across the full spectrum of community, outpatient, inpatient, rehabilitation, and chronic care settings. Access to an <i>ICD</i> code that is relevant to the disease-related nutrition conditions is needed because undernutrition is common among adults exposed to acute and chronic disease burdens.</p><p>The new coding algorithm is applicable when undernutrition is confirmed by the presence of a combination of phenotypic criteria, for example, unintentional weight loss or low body mass index (BMI) or low muscle mass, and etiologic criteria, for example, reduced food intake and/or assimilation (eg, digestive or absorption disorders) or presence of disease, injury, or infection with chronic, relapsing, or acute severe inflammation. Further adjustments to the new coding procedures detailed below may be made during the implementation phase. No specific tool has been mandated for use to meet these criteria, but a tool that incorporates these defined elements is essential.</p><p><b>Undernutrition in adults related to disease with moderate to severe inflammation</b> may be used when undernutrition is confirmed by presence of disease, injury, or infection with chronic relapsing or acute severe inflammation as the major etiologic criterion. <b>Undernutrition in adults related to disease with nondiscernible inflammation</b> may be used when undernutrition is confirmed by presence of reduced food intake and/or assimilation (eg, digestive or absorption disorder) usually caused by disease as the major etiologic criterion. <b>Undernutrition in adults related to starvation</b> may be used when undernutrition is confirmed by presence of reduced food intake owing to hunger or food shortage associated with socioeconomic or environmental factors. These may include starvation in settings of poverty and food insecurity, and catastrophes like war, natural disasters, and famine. Additional descriptors for any of the ab","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"352-354"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aspenjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic profiles in adults with trauma receiving enteral nutrition support: A metabolomic cohort study","authors":"Grant E. O'Keefe MD,&nbsp;Sandi L. Navarro PhD, MS,&nbsp;Zihan Zheng MS,&nbsp;Timothy W. Randolph PhD,&nbsp;Marilyn Shelton RD,&nbsp;Norma Elizaga MD,&nbsp;Qian Qiu MBA,&nbsp;Gowda G. A. Nagana PhD,&nbsp;Daniel Raftery PhD","doi":"10.1002/jpen.70051","DOIUrl":"10.1002/jpen.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to identify metabolic changes after injury and potential mechanisms whereby nutrition support may influence metabolites and pathways. We analyzed 45 metabolites in 67 trauma patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a metabolomic cohort study in critically ill adults with trauma using nuclear magnetic resonance to quantify 45 metabolites in plasma. We divided the cohort into two groups based on the median amount of protein intake calculated by averaging over the first 7 days of nutrition support. Using linear mixed models, we tested the hypotheses that metabolite concentrations would differ over time and the rate of change is altered by the amount of enteral protein intake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five metabolites in each of the low (median = 0.6 [IQR, 0.4–0.8] gm/kg/day) and high (1.5 [1.1–1.7] gm/kg/day) protein intake groups were different by day 3 compared with baseline. Twenty metabolites in the low–protein intake group and 14 metabolites in the high–protein intake group were different by day 7 compared with baseline. There was no evidence that the rate of metabolite change over time differs by protein intake group. Quantitative enrichment analysis indicated that branched chain amino acid (BCAA) catabolism was one of the most altered pathways in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In critically ill trauma patients, metabolites, particularly those linked with BCAA metabolism, are altered over time but not influenced by the amount of enteral protein intake during the first week.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"385-393"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a computational recommendation system for parenteral nutrition prescription: An algorithm study","authors":"Ashley Bond MD,&nbsp;Simon Harrison MPharm,&nbsp;Simon Lal PhD,&nbsp;Luciano Gerber PhD","doi":"10.1002/jpen.70053","DOIUrl":"10.1002/jpen.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is a drive in some countries to increase the use of multichamber bags as an alternative to compounded parenteral support for patients with chronic intestinal failure to preserve aseptic pharmacy capacity. If a required regimen is that of a multichamber bag plus one intravenous fluid product, then the potential combinations of available products can exceed 3000.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A computer-based selection algorithm known as “PNMatch” was developed, which uses a “k-nearest neighbor” strategy for matching. After completion of the computational design for the algorithm, a staged testing and development process was undertaken, evaluating the algorithm against clinician prescribing. A matching assessment was then undertaken against existing prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Algorithm functionality was assessed through 20 parenteral nutrition formulation requests, all of which were successfully processed. Prescription selection demonstrated a 90% exact match rate, with one unmatched case and one nonimproved match. The mean time for prescription selection using PNMatch was 116 s. Multichamber bag requests were then evaluated. Most prescriptions matched closely with the existing formulations, achieving a Cohen kappa value of 0.8. Further analysis of 44 formulation requests showed successful product selection for 43 requests. The mean difference in volume was −75.3 ml, and for potassium, it was −4.9 mmol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first demonstration of the successful development and testing of a computer-based selection algorithm for the prescription of a multichamber bag–based regimen for patients with chronic intestinal failure. This has the potential to improve efficiency and reduce variability in parenteral support prescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"359-365"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase angle reference values in healthy Chinese adults: A descriptive cross-sectional study","authors":"Na Yang MD,&nbsp;Wanyang Li PhD,&nbsp;Mingyao Sun PhD,&nbsp;Xiaodong Shi BD,&nbsp;Rongrong Li MD,&nbsp;Wei Chen MD","doi":"10.1002/jpen.70062","DOIUrl":"10.1002/jpen.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Phase angle serves as a robust indicator of cellular integrity and overall health status. However, reference values for phase angle among healthy Chinese adults remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a multicenter descriptive cross-sectional study in healthy Chinese adults from 2021 to 2024. Our primary outcome was phase angle, calculated from the relationship between resistance and reactance measured directly by bioelectrical impedance analysis. Standardized anthropometric and bioelectrical impedance analysis assessments were conducted. We examined associations of phase angle with age, sex, and body mass index using multivariable linear regression and generated sex-, age-, and body mass index–stratified percentiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 40,074 healthy adults (46.9% men; mean ± SD age 42.8 ± 12.9 years; mean ± SD body mass index 24.2 ± 3.5 kg/m²) who attended routine health examinations at three hospitals in Northern, Eastern, and Southwestern China. The mean ± SD phase angle was 5.52 ± 0.79°, with significantly higher values in men compared with women (5.95° vs 5.14°, <i>P</i> &lt; 0.001). Phase angle positively correlated with body mass index (<i>r</i> = 0.35) and negatively with age (<i>r</i> = −0.20) (both <i>P</i> &lt; 0.001). Peak phase angle values were observed in individuals aged 30–39 years and declined thereafter. Device type showed no significant effect on phase angle measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We established the first large-scale, sex-, age-, and bioelectrical impedance analysis–specific phase angle reference ranges for healthy Chinese adults. These normative values provide an essential foundation for clinical application of phase angle in health assessment, early disease screening, and individualized nutrition and medical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"421-429"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for nutrition in adults with head and neck cancer: The American Society for Parenteral and Enteral Nutrition","authors":"Nicole Kiss PhD,&nbsp;Merran Findlay PhD,&nbsp;Jacqui Frowen PhD, SP,&nbsp;Whitney E. Lewis PharmD,&nbsp;Jeannine Mills MS, RDN,&nbsp;Anurag K. Singh MD,&nbsp;David D. Church PhD,&nbsp;Jacob T. Mey PhD, RD,&nbsp;Sarah Peterson PhD, RD,&nbsp;Kathleen Aguzzi RD,&nbsp;Sarah Bellini PhD, RDN,&nbsp;Maria Paula Villela Coelho MD,&nbsp;Laura Cordwin MMN, RDN,&nbsp;Michael Duffy MS, RD,&nbsp;Shanna Hager PharmD,&nbsp;Manpreet S. Mundi MD,&nbsp;Michael Owen-Michaane MD,&nbsp;Kathleen Price PhD, RDN,&nbsp;Heather Stanner MS, RD,&nbsp;Bridget Storm MA,&nbsp;Malika Udagedara MD, MSc,&nbsp;Liam McKeever PhD, RDN","doi":"10.1002/jpen.70067","DOIUrl":"10.1002/jpen.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Head and neck cancer represents the seventh most common cancer diagnosis globally. Maintaining sufficient nutrition is important for preventing malnutrition (undernutrition) and muscle wasting, which contribute to worse outcomes, although many patients are unable to maintain adequate oral intake throughout treatment. This guideline provides practice guidance on nutrition care for patients with head and neck cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An interdisciplinary team developed key questions and scanned results from a systematic search of the PubMed, EMBASE, CINAHL, and Cochrane Central databases back to 2001. Recommendations were created for key questions concerning timing and duration of nutrition support (early vs delayed enteral nutrition [EN], postoperative feeding, and perioperative dietitian intervention), frequency of dietitian and speech pathology consultations, nutrition screening and assessment, macronutrient requirements, enteral access devices, adjunctive strategies (appetite stimulants and continuation of oral intake alongside EN), specialized nutrients (arginine, glutamine, ω-3, and immunonutrition), and interdisciplinary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-two studies were included. Recommendations were made supporting early initiation of EN when oral intake is inadequate, nutrition within 24 h after surgery, weekly consultation with a dietitian during radiotherapy, malnutrition screening and assessment with validated tools, interdisciplinary models of care, dietitian involvement before and after surgery, and when to consider use of specialized nutrients. Recommendations are also provided for protein intake (1.2–1.5 g/kg/day) and energy intake (≥30 kcal/kg/day).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This guideline provides guidance for the nutrition care of patients with head and neck cancer, identifies research gaps, and calls for standardized outcome reporting to further the state of the evidence. This paper was approved by the ASPEN Board of Directors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"274-338"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the dietary index for gut microbiota and advanced cardiovascular-kidney-metabolic syndrome among United States adults: A cross-sectional study","authors":"Xin Zhang MM,&nbsp;Xueyi Lin MM,&nbsp;Wanchao Zhang MB,&nbsp;Tiewu Tan MB,&nbsp;Xiaoyu Han MB,&nbsp;Yijiang Ni MD,&nbsp;Hui Qin MD","doi":"10.1002/jpen.70056","DOIUrl":"10.1002/jpen.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traditional dietary measures, which reflect overall dietary health, provide limited insight into gut microbiota. We hypothesize that a higher dietary index for gut microbiota is associated with decreased incidence of advanced cardiovascular-kidney-metabolic syndrome and aim to investigate this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the 2007 to 2020 National Health and Nutrition Examination Survey to conduct a cross-sectional study of United States adults. The dietary index for gut microbiota was derived by quantifying and scoring 14 dietary components from the dietary recall interviews, while cardiovascular-kidney-metabolic syndrome was evaluated in accordance with the guidelines issued by the American Heart Association. The relationship between the dietary index for gut microbiota and advanced cardiovascular-kidney-metabolic syndrome was assessed using weighted logistic regression, restricted cubic splines, subgroup, and sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14,406 cardiovascular-kidney-metabolic syndrome participants were included, with 9782 classified as non-advanced and 4624 as advanced. After adjusting for potential covariates, both logistic regression and restricted cubic splines revealed a significant negative correlation between the dietary index for gut microbiota and advanced cardiovascular-kidney-metabolic syndrome, with an adjusted odds ratio of 0.57 (95% confidence interval: 0.50, 0.65) for the fourth quartile in comparison to the reference group, which was strengthened in individuals with higher education and non-smokers (both <i>P</i> for interaction &lt;0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A higher dietary index for gut microbiota is associated with decreased incidence of advanced cardiovascular-kidney-metabolic syndrome. Additional prospective cohort studies are required to validate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"440-447"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication errors involving parenteral nutrition preparations and concentrated electrolytes in a pediatric hospital: A qualitative analysis","authors":"Justiina Tuomisto MSc,&nbsp;Anna-Riia Holmström PhD,&nbsp;Sini Kuitunen PhD","doi":"10.1002/jpen.70049","DOIUrl":"10.1002/jpen.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parenteral nutrition and concentrated electrolytes are associated with medication errors in pediatrics; however, a systems-based understanding of these errors is lacking. We aimed to describe the errors, contributing factors, and proposed defenses related to these medications in pediatrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study analyzed self-reported medication safety incidents at a pediatric university hospital between 2018 and 2020, focusing on parenteral nutrition and concentrated electrolytes. The reports were investigated through qualitative content analysis, and the results were quantified in frequencies and percentages. Consequently, the Institute for Safe Medication Practices′ Hierarchy of Effectiveness of Risk-Reduction Strategies was used to categorize the proposed safety defenses. The analysis used a systems approach to medication risk management, guided by the theory of human error.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 404 medication errors, 627 contributing factors, and 386 proposed defenses were identified within the study sample (<i>n</i> = 279 incident reports). Most errors occurred during the administration (54%) and preparation (25%) phases. Common issues included wrong dose (15%), wrong infusion rate (11%), and incorrectly prepared medicine (18%). Contributing factors were often linked to workload and resources (22%) and employee-related factors (21%). Most proposed defenses were classified as low leverage (71%), with the smallest portion at the highest leverage (6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Errors often occur during preparation and administration, primarily because of the complexity of individualized dosing. Contributing factors include high workload, limited resources, and employee-related factors. Hospitals should prioritize implementing systems-based, technology-driven defenses over person-focused strategies. Future research is essential for developing and evaluating child-specific defenses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"374-384"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of height-standardized calf circumference and mid-arm circumference with overall survival in adults with cancer: A retrospective cohort study","authors":"Jia-Xin Huang MD,&nbsp;Xiang-Ting Dai MD,&nbsp;Xin-Rui Hu PhD,&nbsp;Min Yang PhD,&nbsp;Meng Tang PhD,&nbsp;Li Deng PhD,&nbsp;Chun-Hua Song PhD,&nbsp;Wei Li PhD,&nbsp;Xi Zhang PhD,&nbsp;Han-Ping Shi PhD,&nbsp;Ming-Hua Cong PhD","doi":"10.1002/jpen.70048","DOIUrl":"10.1002/jpen.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Body size may influence anthropometric measurements' performance in survival prediction. Our study aimed to develop standardized calf and mid-arm circumferences and compare their prognostic value with that of unstandardized forms in patients with cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective cohort study included 15,826 patients. Malnutrition was assessed using the Patient-Generated Subjective Global Assessment with a score ≥4. The concordance index (<i>C</i>-index) and receiver operating characteristic (ROC) curves were used to compare predictive power. Cox and logistic regression analyses were performed to identify the independent factors associated with survival and malnutrition, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The highest <i>C</i>-index and the area under the ROC curve (AUC) values were observed for height-standardized calf and mid-arm circumferences (<i>C</i>-index: 0.584 and 0.585; 1-year AUC values: 0.600 and 0.600; and 3-year AUC values: 0.597and 0.594, respectively). Compared with unstandardized calf circumference, the height-standardized measure improved the predictive power for survival (difference = 0.020; <i>P</i> &lt; 0.001). Similarly, height-standardized mid-arm circumference showed superior predictive ability (difference = 0.015; <i>P</i> &lt; 0.001). Additionally, height standardization enhanced the predictive accuracy of calf and mid-arm circumferences for malnutrition (calf circumferences: difference = 0.014, <i>P</i> &lt; 0.001; mid-arm circumferences: difference = 0.008, <i>P</i> &lt; 0.001). Height-standardized calf and mid-arm circumferences were independent prognostic factors of survival and risk factors for malnutrition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Height-standardized calf and mid-arm circumferences were independently associated with survival and malnutrition in patients with cancer. Although the improvements in predictive performance were modest, height standardization may improve the clinical utility of anthropometric assessments by accounting for differences in body size.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"402-411"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for carnitine deficiency in critically ill adults: A descriptive cross-sectional study","authors":"Jennifer Gordon DCN, RD,&nbsp;Rebecca Brody PhD, RD,&nbsp;Hamed Samavat PhD, RD,&nbsp;Mireille Hamdan DCN, RD,&nbsp;Alexander L. Colonna MD, MSCI,&nbsp;Jason B. Young MD, PharmD,&nbsp;Laura D. Byham-Gray PhD, RD","doi":"10.1002/jpen.70044","DOIUrl":"10.1002/jpen.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Critical illness is a risk factor for carnitine deficiency. Carnitine deficiency may result in serious medical complications and poor clinical outcomes. This study aimed to identify the prevalence and potential predictors of carnitine deficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a descriptive cross-sectional study conducted in a convenience sample of 144 critically ill adults admitted to a surgical or cardiovascular intensive care unit at the University of Utah Hospital, with serum carnitine levels measured from January 1, 2022, to December 31, 2024. Binary and multivariable logistic regression models were constructed to explore potential predictors of carnitine deficiency, which was defined as a free serum carnitine level &lt;36 µmol/L.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of patients was 56.5 years; 41.7% of the sample had carnitine deficiency. For each unit decrease in body mass index, the odds of developing carnitine deficiency increased by 5% compared with maintaining normal free carnitine status (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.9–0.99). Those prescribed continuous renal replacement therapy were 2.43 times more likely to develop carnitine deficiency than those not on continuous renal replacement therapy (OR, 2.43; 95% CI, 1.12–5.25).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A high proportion of our study population had carnitine deficiency. Continuous renal replacement therapy and a lower body mass index were significant predictors in the multivariable model. Female sex and a history of chronic kidney disease may warrant further exploration based on significance in the univariable analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"394-401"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surrogate measure of gut blood flow via superior mesenteric circulation on ultrasound in adults who underwent esophagectomy: A descriptive cohort study","authors":"Tomonori Narita MD,&nbsp;Kazuhiko Fukatsu MD, PhD,&nbsp;Reo Inoue MD, PhD,&nbsp;Satoshi Murakoshi MD, PhD,&nbsp;Midori Noguchi BA,&nbsp;Nana Matsumoto RD, MS,&nbsp;Shoh Yajima MD, PhD,&nbsp;Koichi Yagi MD, PhD,&nbsp;Yoshifumi Baba MD, PhD","doi":"10.1002/jpen.70058","DOIUrl":"10.1002/jpen.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early enteral nutrition is recommended for critically ill patients. However, feeding an ischemic gastrointestinal tract with enteral nutrition may lead to gut necrosis. Although gut tolerance of enteral nutrition is assessed by various symptoms, none of them provide conclusive evidence of gut ischemia. We investigated the blood flow in the superior mesenteric artery and vein using ultrasonography after esophagectomy along with conventional physical findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 30 patients who underwent esophagectomy at The University of Tokyo Hospital from October 2022 to July 2023. Superior mesenteric artery, vein, and common carotid arteries blood flow were measured during the preoperative fasting period and on postoperative days 1, 2, 3, 5, 7, and 9. The relationships between blood flow and physical findings were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Superior mesenteric artery and vein blood flows were lower on postoperative day 1 than during the preoperative fasting period (superior mesenteric artery: 81% <i>P</i> = 0.03, superior mesenteric vein: 85% <i>P</i> = 0.01) but recovered to preoperative levels after postoperative day 2. Common carotid artery blood flow remained constant perioperatively. None of the physical findings observed correlated with the superior mesenteric artery and vein blood flows at any time point. Superior mesenteric artery and vein blood flows increased when enteral nutrition was initiated. No cases of gut necrosis were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the relatively severe insult, gut blood flow recovered promptly. As traditional indicators did not correlate with gut blood flow, routine measurement of superior mesenteric artery and vein blood flows may allow assessment of potential gut hypoperfusion after major surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 3","pages":"430-439"},"PeriodicalIF":4.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}